Factors associated with high cholesterol levels in Lusaka, Zambia: a community-based study

Background: High cholesterol level is a risk factor for cardiovascular disease. The objective of the study was to estimate the prevalence and correlates for high cholesterol levels in Lusaka district, Zambia.Methods: A modified World Health Organization STEPwise approach to surveillance method was used to collect data among adults. Odds ratios and their 95% confidence intervals were used to estimate magnitudes of associations.Results: A total of 1928 individuals participated in the survey. Overall, 15.8% (12.8% among male and 17.3% among female, p=0.013) respondents had high cholesterol levels. Compared to males aged 45 years or older, males of age 25-34 years were 44% less likely to have raised cholesterol levels. Males with body mass index (BMI) <18.5 and 25.0-29.9 were 87% less and 2.49 times more likely to have raised cholesterol, respectively, compared to males with BMI of 30 or more. Meanwhile, females aged 25-34 years were 22% less likely to have raised cholesterol compared to females aged 45 years or older. Compared to females with BMI of 30 or more, females with BMI of 18.5-24.9 and 25.0-29.9 were 33% less and 57% more likely, respectively, to have raised cholesterol levels.Conclusion: A series of surveys to determine changes in total and LDL cholesterol are needed to estimate changes in the health level of the residents in Lusaka. These results could be used in the formulation of an action plan to prevent and control high cholesterol and its consequences among Zambian urban residents

Seroprevalence of West Nile Virus specific IgG and IgM antibodies in North-Western and Western provinces of Zambia

Background: West Nile Virus (WNV) infection has been reported worldwide, including in Africa but its existence in Zambia is unknown. Symptoms for the virus include headache, myalgia, arthralgia and rash.Objectives: This study aimed to determine the seroprevalence of WNV and its correlates.Methods: A cross sectional study was conducted in North-Western and Western provinces of Zambia. Samples were subjected to IgG and IgM antibodies testing against WNV. Logistic regression analyses were conducted to determine magnitudes of association.Results: A total of 3,625 of persons participated in the survey out of which 10.3% had WNV infection. Farmers were 20% (AOR=0.80; 95% CI [0.64, 0.99]) less likely to have infection compared to students. Meanwhile participants who lived in grass roofed houses were 2.97 (AOR=2.97; 95% CI [1.81, 4.88]) times more likely to be infected than those who lived in asbestos roofed houses. IRS was associated with reduced risk of infection (AOR=0.81; 95% CI [0.69, 0.94]). Travelling to Angola was associated with the infection [AOR=1.40; 95% CI [1.09, 1.81].Conclusion: Spraying houses with insecticide residual spray would minimize mosquito-man contact. Furthermore, surveillance at the border with Angola should be enhanced in order to reduce importation of the virus into the country.Keywords: Seroprevalence, West Wile Virus, Western province, North-Western province, Zambi

Cholera Epidemiology in Zambia from 2000 to 2010: Implications for Improving Cholera Prevention and Control Strategies in the Country

Objective: To review the cholera epidemiology in Zambia from 2000 to 2010 in order to highlight the key lessons learned. Based on our findings, we make recommendations for improving cholera prevention and control in country.Design: Ten years descriptive cholera data was extracted from the national IDSR database and analysed.Setting: The study was conducted in Zambia using national epidemiology data which were disaggregated by Province.Subjects: NoneResults : Starting from 2003, there has been a progressive increase in yearly incidence of cholera in the country. In 2010, 6794 cases (500% increase compared to 2003) and 115 deaths (CFR 1.6%) of the disease were reported with Lusaka Province accounting for 85% of the total cases. Outbreaks start between epidemiological weeks 40 to 45 of the year and ends between weeks 20 to 25 of the following year (which correspondsto the Zambian rainy season). Outbreaks are largely confined to the peri-urban areas of Lusaka, Luapula, Southern and Copperbelt Provinces.Conclusion: In the last 10-20 years, the epidemiology of cholera in Zambia has changed; Laboratory confirmation of Vibrio cholerae in the country on a yearly basis in the last ten years suggests that the country is now endemic for cholera hence the need to review current cholera prevention and control strategies

Significant decline in lymphatic filariasis associated with nationwide scale-up of insecticide-treated nets in Zambia.

Lymphatic filariasis (LF) is a mosquito-borne disease, broadly endemic in Zambia, and is targeted for elimination by mass drug administration (MDA) of albendazole and diethylcarbamazine citrate (DEC) to at-risk populations. Anopheline mosquitoes are primary vectors of LF in Africa, and it is possible that the significant scale-up of malaria vector control over the past decade may have also impacted LF transmission, and contributed to a decrease in prevalence in Zambia. We therefore aimed to examine the putative association between decreasing LF prevalence and increasing coverage of insecticide-treated mosquito nets (ITNs) for malaria vector control, by comparing LF mapping data collected between 2003-2005 and 2009-2011 to LF sentinel site prevalence data collected between 2012 and 2014, before any anti-LF MDA was started. The coverage of ITNs for malaria was quantified and compared for each site in relation to the dynamics of LF. We found a significant decrease in LF prevalence from the years 2003-2005 (11.5% CI95 6.6; 16.4) to 2012-2014 (0.6% CI95 0.03; 1.1); at the same time, there was a significant scale-up of ITNs across the country from 0.2% (CI95 0.0; 0.3) to 76.1% (CI95 71.4; 80.7) respectively. The creation and comparison of two linear models demonstrated that the geographical and temporal variation in ITN coverage was a better predictor of LF prevalence than year alone. Whilst a causal relationship between LF prevalence and ITN coverage cannot be proved, we propose that the scale-up of ITNs has helped to control Anopheles mosquito populations, which have in turn impacted on LF transmission significantly before the scale-up of MDA. This putative synergy with vector control has helped to put Zambia on track to meet national and global goals of LF elimination by 2020

Epidemiology of the 2016 Cholera Outbreak of Chibombo District, Central Zambia

Background: The first outbreak of cholera in Zambia was reported in 1977/1978, and then cases appeared again in 1982/1983. The first major outbreak occurred in 1990 and lasted until 1993. Since then, cholera cases have been registered every year except in 1994 and 1995. Generally most cases were recorded in the fishing camps of the rural areas and in the peri-urban areas of Lusaka and Copperbelt provinces. There is no documented evidence of previous cholera outbreaks in Chibombo district. An outbreak of cholera occurred in this area in 2016. The aim of the study was to document the epidemiological features of this outbreakMethods: We used routine data of suspected and confirmed cholera cases in this area which covered the period from 09th February to 20th March 2016. Available information on the patients included stool culture results, household, sex, and age. Descriptive analysis involved the frequency of the various variables as percentages.Results: A total of 23 suspected and confirmed cases were seen at the district health facility. Thirteen of the cases (57%) were from the same catchment area of which 4 (31%) were from the same household. Of these 10 were female. Of these 20 (87%) were adults and 3(13%) were children. Stool culture results were available for 18 (78%) of which 8 (45%) were positive for vibrio cholera. Of the cases that tested positive the index case was identified as a 62 year old woman who had travelled from an area experiencing an outbreak in Lusaka. On the other hand, of the 11 water samples available 2 (18%) were found to have faeces coliforms contamination. All patients were treated with ciprofloxacin and intravenous fluids. There was no related mortality.Discussion: This was an imported outbreak with the index coming from an area experiencing an epidemic in Lusaka. Possible sources could have included water contaminated with faeces matter. There is need to raise awareness of cholera transmission whenever the country is experiencing outbreaks of cholera.Conclusion: Even areas that have never experienced cholera outbreaks are at risk and there is need to raise awareness

Private sector involvement in the control of contagious bovine pleuropneumonia (CBPP) in the Kazungula district of Zambia benefitted the community and the control strategy

Contagious bovine pleuropneumonia (CBPP) is a disease of economic importance that is widely distributed in sub-Saharan African and contributes significantly to cattle morbidity and mortality. Lack of resources to implement eradication measures has led to the disease becoming endemic in most areas in sub-Saharan Africa where governments have little resources and the majority of the people are poor. Usually, control and eradication of such diseases as CBPP is treated as a public good by governments and to achieve this, governments are usually assisted by nongovernment organisations, bilateral government programmes and international donors. The private sector, which usually is companies that run businesses to make profit, although not very well established in sub-Saharan Africa could play a big role in the eradication of CBPP in the region. This could play a dual role of promoting investment and also eradicate livestock diseases which have proved a menace in the livestock sector. This paper highlights the role played by the private sector in the control of CBPP in Zambia

Acute Flaccid Paralysis Surveillance in Zambia: Progress towards the Polio End Game

Background: In the global polio eradication initiative acute flaccid paralysis cases are followed up two to three months after onset of paralysis to assess recovery of the children. In Zambia AFP cases are followed up regularly but there is no documentation of the clinical and laboratory findings. The purpose of this paper is to document the support WHO country office offers to the follow up of the AFP cases in Zambia to identify gaps which the WHO Country office could address.Methods: This study used secondary data from a case control study design, conducted and supported by WHO country office, which was aimed at assessing the association of NPEVs with AFP. Particularly this study aims at assessing the presence or absence of residual paralysis and the laboratory findings of the affected children.Results: A total of 93 cases of, which over 55% were males were included in this study. Majority of the cases were aged between 24 and 35 months (28.4%). Regarding vaccination status, 77% of the cases had received 1 to 4 doses of the Oral Polio (OPV) vaccine. About 62% of the viruses isolated were identified as Cox B, and Echo 3, 6, 7, 11, 12, 14 and 29. Of all NPEVs 37.1% yielded no neutralization pattern. Only 9 (9.67%) cases were followed up; out of which 3 (33.3%) had residual paralysis with one of those with residual paralysis who later died.Conclusion: AFP surveillance and follow up of cases is carried out in Zambia. However, rehabilitation information of the affected children is not followed up, an issue which WHO country office with regards to the transformation agenda could pursue to ensure that the affected children are adequately supported as a contribution to the polio eradication end game

Evaluation of the implementation of the reaching every district approach in routine immunisation in Lusaka District, Zambia

Background: In 2003, the Government of Zambia in collaboration with implementing partners in immunisation introduced the Reaching Every District (RED) strategy to improve immunization coverage. The aim of this study is to evaluate the implementation of the RED strategy in Lusaka district.Methods: A questionnaire was administered among health centres in charge of all governmental health clinics in Lusaka districts (N = 27). RED implementation was quantified by calculating a RED implementation score (IS) for each of the RED components on a scale of 0 (low implementation score) to 5 (high implementation score).Results: The mean overall RED implementation score was 3.5. The RED component of linking services with community and re-establishing outreach were the two weakest components.Conclusions and recommendations: This evaluation showed that there are a number of elements of the RED strategy which are well implemented; however, some elements need further improvements. There is need for more research on the implementation of the RED strategy in Zambia in order to identify bottlenecks for improving immunization coverage at larger scale and a wider participation.Keywords: RED, Immunization, training, outreach, community links, monitoring, planning, supportivesupervision

Prescribing Patterns and Medicine Use at the University Teaching Hospital, Lusaka, Zambia

Background: There is paucity of data on rational drug use studies at tertiary hospitals in Zambia. The aim of this study was to assess the extent of rational drug use at the adults and paediatrics outpatient departments of the University Teaching Hospital (UTH) using World Health Organization (WHO) standardized drug-use indicators.Methods: Cross-sectional, descriptive, retrospective study of prescription encounters, selected using systematic random sampling methods was conducted at the adult and paediatric outpatient departments of UTH. WHO format of core and complimentary drug use indicators were used to collect prescribing indicators, patient care data which included consultation time, dispensing time and knowledge of correct dosage.Results: A total of 1486 drugs encounters were prescribed from both adult and paediatric outpatient wings in 2015. The average number of drugs per prescription was 2.5(SD±1.58), with a range of 1 to 7 drugs per prescription. The antibiotic and injection-prescribing rate was 53.7% and 11.8%respectively. Generic prescribing was at 56.1%. Percentage of drugs prescribed from the Zambia Essential Medicines List (ZEML) was 98.1%. Average consulting and dispensing time was 9.5 minutes and 1.3 minutes respectively. Percentage of patients with knowledge of correct dosing schedule was 78.9%. Labelling of medicines was adequate. All consultation rooms did not have Standard Treatment Guidelines (STG's) or any reference literature and were not connected to the internet.Conclusion: Low rate of injection prescribing was rational but consultation times were shorter than recommended and therefore irrational. High rate of antibiotic prescribing was irrational going by WHO standards for health facilities and this could lead to microbial resistance. Brand name prescribing was also irrational and common. Prescribing outside the ZEML was minimal and rational